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Case Reports
. 2021 Nov 16;9(11):e3934.
doi: 10.1097/GOX.0000000000003934. eCollection 2021 Nov.

Frontal Cranioplasty with Vascularized Split-iliac Crest Bone Flap

Morgan E Baudoin  1 , Patrick A Palines  2 , Mark W Stalder  2   3
Affiliations
Case Reports

Frontal Cranioplasty with Vascularized Split-iliac Crest Bone Flap

Morgan E Baudoin et al. Plast Reconstr Surg Glob Open. .

Abstract

Defects of the frontal bone require thoughtful consideration of reconstructive material to satisfy the aesthetic and functional demands of the region, as well as the anatomic adjacency to the frontal sinus. Some cases may be further complicated by a suboptimal operative field due to prior radiation, reconstructive procedures, or infection. Vascularized bone offers an ideal option to successfully reconstruct bony defects in harsh wound beds. Here, we report the case of a 47-year-old man with adenoid cystic carcinoma who underwent secondary reconstruction of the frontal bone with a split-iliac crest bone flap based on the deep circumflex iliac artery. The patient's course following an initial ablative procedure was complicated by recurrent periorbital cellulitis, radiation, and eventual recurrence of the malignancy. Reconstructive requirements included restoration of the superior orbital rim, cranialization of the frontal sinus, and reconstruction of a sizeable frontal bone defect. In this setting, the iliac crest served as an excellent reconstructive option owing to its natural curvature and large surface area. The split-iliac crest deep circumflex iliac artery bone flap offers a robust and valuable reconstructive option for calvarial defects in hostile surgical fields.

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Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to content of this article. This study did not receive any funding.

Figures

Fig. 1.
Fig. 1.
Vascularized iliac crest cranioplasty in a 47-year old man with recurrent adenoid cystic carcinoma. A, Frontal bone and sinus defect after resection of recurrent adenoid cystic carcinoma in the setting of prior radiation, surgery, and infection. B, DCIA split-iliac crest bone flap after trimming to fit the bony defect. C, The DCIA bone flap was inset using titanium miniplates, and microvascular anastomosis was performed to the contralateral superficial temporal vessels using a composite arterial/venous vascular graft from the descending branch of the lateral femoral circumflex system. D, Postoperative CT scan demonstrating inset of vascularized iliac crest bone flap.
See this image and copyright information in PMC

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